The Black Community, COVID-19 & Trauma

An Interview with CA Surgeon General Dr. Nadine Burke Harris

By Latanya West

In January 2019, Governor Gavin Newsom appointed Dr. Nadine Burke Harris as California’s first-ever Surgeon General. An award-winning physician, researcher and advocate, Dr. Burke Harris’ career has been dedicated to serving vulnerable communities and combating the root causes of health disparities. Her work is equally dedicated to changing the way our society responds to one of the most serious, expensive and widespread public health crises of our time: childhood trauma.

Dr. Burke Harris recently shared information with Voice & Viewpoint about the heightened levels of stress we are all feeling right now in the wake of the coronavirus, how underserved communities experience toxic stress and trauma differently, and ways to identify and manage stress and anxiety during this time, for our overall health – both physical and mental.

(This interview was conducted on April 17, 2020.)

Voice & Viewpoint (V&V): How can people help themselves to manage the very real stress they are experiencing right now with the coronavirus crisis?

Dr. Burke Harris (BH): We’ve published a California Surgeon General’s Playbook: Stress Relief during COVID-19 . Two Playbooks, one for adults and one caregivers can utilize with children. (PUBLISHER’S NOTE: Visit https://covid19.ca.gov/ and enter the search term “SURGEON GENERAL PLAYBOOK” to access this essential resource)

Start by checking in with yourself. Pay attention to how stress shows up with you. Perhaps you are more moody, or your appetite changes, or your sleep is disrupted. You might experience headaches, tummy aches, neck tension, or you have greater challenges managing your blood pressure or blood sugar levels.

What’s important to know is that it’s not all in your head. Our bodies are making more stress hormones right now and that can show up emotionally or physically. It’s a natural part of the body’s stress response.

There is good science on how to help ourselves: 30 to 60 minutes of exercise a day, good sleep hygiene, and establishing regular routines, even if we may not be getting up and going to work right now or taking the kids to school. It’s important behaviorally and biologically, to really stay connected.

VV: What is ” toxic stress” vs. “trauma”? Aren’t they the same?

BH: They are not the same. Toxic stress is a response to the body’s biological response, like when you have an accident, or you are harmed or victimized in some way.

When we say, “trauma”, we are referring to a physiological trauma – especially for the Black community. When we talk about adverse childhood experiences, such as mental health, parental separation – the 10 traditional adverse childhood experiences (ACEs) identified by the CDC* – many of my patients experienced those things, but they didn’t see them as “trauma.” For them, it was ‘just life,’ or the ‘drama’ experienced in everyday life. Many viewed ‘trauma’ as something happening to someone else.

In fact, the more a person has exposure to those 10 adverse childhood experiences, their bodies, over time, are exposed to an overactivity of the biological stress response, and that leads to serious illness.

The scientific community hasn’t recognized until recently that a person can still have an overactive stress response that affects your health, even when no outward symptoms of stress are evident. A patient may go on with their lives, and suffer no outward signs of depression or anxiety, for instance.

So when we talk about black and brown people being more susceptible to Covid-19, we have to look at stress and the wear and tear on the black body. Both from a behavioral and mental health standpoint, but, equally important, from a physical standpoint. It is cumulative.

VV: Could underserved communities be experiencing the COVID-19 crisis differently? Are there unique challenges?

BH: The entire state can learn from the black community. I spent my clinical career in San Francisco, serving in Bay View, one of the city’s stablest historically black communities in the San Francisco area. A black person can’t walk down the street without a tip of the hat or some sort of eye contact. It has a really strong and rich tradition of maintaining social supports, which is important. That’s what we do! It comes from a history of preserving through adversity that others can learn from at this moment.

[There must be] a recognition that African Americans experience higher doses of adversity. Higher doses of stress, particularly from past childhood experiences, put us at greater risk for subsequent stressors. The science is clear: stress can accumulate in our bodies. It gets under our skin and changes our biology. For African Americans, that means we’re at greater risk for asthma, heart disease, and diabetes. Risk factors have far worse outcomes for African Americans if we then contract the coronavirus.

There has been a lot of conversation as to why African Americans are more vulnerable and have worse Covid outcomes. What’s behind the national data? This is not a mystery. It is well documented. African Americans are more likely to work in service jobs that require them to work [outside of the home] right now. In grocery stores, and transportation jobs, for example. We have less access to high quality health care – or even access to health care at all. This didn’t come out of nowhere. It comes from generations of government policies and decisions. It is incumbent that we acknowledge that.

When we look at the distrust of African Americans and the health establishment, it can impact the likelihood of us not following suggested guidelines. The only way to combat that is if we change our behavior

As a government and in my role as surgeon general there has been very very thoughtful attention and concrete steps made to put protections in place for our vulnerable communities.

VV: Can you give us some examples?

BH: For example, issuing protections against evictions and water shut offs; investing $125 million in public private partnerships to help undocumented people receive cash assistance. Governor Newsom is making real steps to ensure vulnerable populations get the care they deserve – and that testing is made free for folks. It’s great if you are in a hospital, but what if you’re getting care at a community clinic, where many African Americans get care?

VV: What about people who want to be tested?

BH: We, as a state, are ramping up our testing capacity. If you are well, don’t come in! We want to make sure that, as a state, we have the capacity to treat severe cases of COVID-19 and our capacity is changing, with more capacity everyday.

If you are experiencing shortness of breath, high fever, feeling weak or like you’re struggling to get out of bed, then it’s really time to seek a higher level of care. Call your doctor. If you have an underlying condition, you will be at greater risk and your doctor will know your health history and be able to advise you.

*ACEs identified by the CDC include Abuse, Neglect, and Household Dysfunction: physical abuse, verbal abuse, sexual abuse, physical neglect, and emotional neglect, a parent who’s an alcoholic, a mother who’s a victim of domestic violence, a family member in jail, a family member diagnosed with a mental illness, and the disappearance of a parent through divorce, death or abandonment. According to the CDC: “ACEs are preventable. Creating and sustaining safe, stable, nurturing relationships and environments for all children and families can prevent ACEs and help all children reach their full potential.”